BackgroundThe 2009 H1N1 pandemic highlighted the need to routinely monitor severe influenza, which lead to the establishment of sentinel hospital-based surveillance of severe acute respiratory infections (SARI) in several countries in Europe. The objective of this study is to describe characteristics of SARI patients and to explore risk factors for a severe outcome in influenza-positive SARI patients.MethodsData on hospitalised patients meeting a syndromic SARI case definition between 2009 and 2012 from nine countries in Eastern Europe (Albania, Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Romania, Russian Federation and Ukraine) were included in this study. An exploratory analysis was performed to assess the association between risk factors and a severe (ICU, fatal) outcome in influenza-positive SARI patients using a multivariate logistic regression analysis.ResultsNine countries reported a total of 13,275 SARI patients. The majority of SARI patients reported in these countries were young children. A total of 12,673 SARI cases (95%) were tested for influenza virus and 3377 (27%) were laboratory confirmed. The majority of tested SARI cases were from Georgia, the Russian Federation and Ukraine and the least were from Kyrgyzstan. The proportion positive varied by country, season and age group, with a tendency to a higher proportion positive in the 15+ yrs age group in six of the countries. ICU admission and fatal outcome were most often recorded for influenza-positive SARI cases aged >15 yrs. An exploratory analysis using pooled data from influenza-positive SARI cases in three countries showed that age > 15 yrs, having lung, heart, kidney or liver disease, and being pregnant were independently associated with a fatal outcome.ConclusionsCountries in Eastern Europe have been able to collect data through routine monitoring of severe influenza and results on risk factors for a severe outcome in influenza-positive SARI cases have identified several risk groups. This is especially relevant in the light of an overall low vaccination uptake and antiviral use in Eastern Europe, since information on risk factors will help in targeting and prioritising vulnerable populations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0722-x) contains supplementary material, which is available to authorized users.

ObjectiveTo establish the reliability and validity of the translated version of the Safety Attitudes Questionnaire (SAQ) by evaluating its psychometric properties and to determine possible differences among nurses and physicians regarding safety attitudes.DesignA cross-sectional study utilising the Albanian version of the SAQ and a demographic questionnaire.SettingFour regional hospitals in Albania.Participants341 healthcare providers, including 132 nurses and 209 doctors.Main outcome measure(s)The translation, construct validity and internal validity of the SAQ. The SAQ includes six scales and 30 items.ResultsA total of 341 valid questionnaires were returned, for a response rate of 70%. The confirmatory factor analysis and its goodness-of-fit indices (standardised root mean square residual 0.075, root mean square error of approximation 0.044 and comparative fit index 0.97) showed good model fit. The Cronbach's α values for each of the scales of the SAQ ranged from 0.64 to 0.82. The percentage of hospital healthcare workers who had a positive attitude was 60.3% for the teamwork climate, 57.2% for the safety climate, 58.4% for job satisfaction, 37.4% for stress recognition, 59.3% for the perception of management and 49.5% for working conditions. Intercorrelations showed that the subscales had moderate-to-high correlations with one another. Nurses were more hesitant to admit and report errors; only 55% of physicians and 44% of nurses endorsed this statement (χ2=4.9, p=0.02). Moreover, nurses received lower scores on team work compared with doctors (N 45.7 vs D 52.3, p=0.01). Doctors denied the effects of stress and fatigue on their performance (N 46.7 vs D 39.5, p<0.01), neglecting the workload.ConclusionsThe SAQ is a useful tool for evaluating safety attitudes in Albanian hospitals. In light of the health workforce's poor recognition of stress, establishing patient safety programmes should be a priority among policymakers in Albania.

BackgroundIn the last decades, Aedes albopictus has become an increasing public health threat in tropical as well as in more recently invaded temperate areas due to its capacity to transmit several human arboviruses, among which Dengue, Chikungunya and Zika. Enhancing the efficiency of currently used collection approaches, such as ovitraps and sticky traps, is desirable for optimal monitoring of the species abundance, for assessment of the risk of arbovirus transmission and for the optimisation of control activities.FindingsTwo sets of 4 × 4 Latin-square experiments were carried out in Tirana (Albania) to test whether modifications in ovitrap shape and size and in oviposition substrate would increase collections of Ae. albopictus eggs and whether hay-infusion would increase adult catches by sticky trap. Generalized Linear Mixed Models with negative binomial error distribution were carried out to analyse the data. Cylindrical ovitraps lined with germination paper yielded significantly higher egg catches than those exploiting either the (commonly used) wooden paddles or floating polystyrene blocks as oviposition substrates. No difference was observed between cylindrical and conical shaped ovitraps. Ovitraps and sticky traps baited with hay infusion yielded significantly higher egg and adult catches than un-baited ones. A significant relationship between ovitrap and sticky trap catches was observed both in the absence and in the presence of attractants, with ovitrap catches increasing more than sticky trap catches at increasing adult female densities.ConclusionsThis study provides grounds for optimisation of ovitraps and sticky traps as monitoring tools for Ae. albopictus by (i) supporting use of germination paper as most appropriate oviposition substrate; (ii) suggesting the possible use of stackable conical ovitraps for large scale monitoring; (iii) confirming the use of hay-infusion to increase egg catches in ovitraps, and showing that hay-infusion also significant increases adult catches by sticky traps.